Babies born to women in the Netherlands who are considered as having low risk pregnancies and are cared for by a midwife are twice as likely to die as babies born to high-risk women who are looked after by an obstetrician, according to a report in the British Medical Journal.

The report, by researchers at the University of Utrecht teaching hospital, says the findings are ‘unexpected’ and that pregnancy care in the Netherlands ‘needs further evaluation’.
The Dutch childbirth system is based on deciding if a woman is high or low-risk. Low- risk women are looked after by midwives, high-risk pregnancies are supervised by obstetricians.
Specialists
The death rate among the nearly 38,000 births studied was 2.6 per 1,000. For low-risk women the perinatal death rate was ‘significantly higher’ than for high-risk women, the report said. And the death rate for women who were referred to a specialist during labour was even higher, the report said.
This shows ‘the Dutch system of risk selection in relation to perinatal death at term is not as effective as was once thought,’ the researchers said.
The researchers told the Volkskrant that putting all women under the care of an obstetrician is not the answer. One option would be to develop maternity wards and birthing centres where both high and low-risk women gave birth, with obstetricians and midwives on hand.
Delays
‘At the moment, if something goes wrong under the supervision of a midwife, it takes longer to get specialist attention,’ researcher Anneke Kwee told the paper.
Although around 40% of Dutch women plan to give birth at home, only around 22% actually do so.